The effect of TMS on visual motion sensitivity: an increase in neural noise or a decrease in signal strength?

Common framework for "virtual lesion" and state-dependent TMS: The facilitatory/suppressive range model of online TMS effects on behavior

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Transcranial magnetic stimulation can either facilitate or impair behavior.

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Nature of behavioral effects depends on factors such as brain state and intensity.

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We present a common framework to account for these effects.

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There are distinct intensity ranges for facilitatory and suppressive effects of TMS.

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Changes in excitability shift these ranges and account for behavioral effects.

The behavioral effects of Transcranial Magnetic Stimulation (TMS) are often nonlinear; factors such as stimulation intensity and brain state can modulate the impact of TMS on observable behavior in qualitatively different manner. Here we propose a theoretical framework to account for these effects. In this model, there are distinct intensity ranges for facilitatory and suppressive effects of TMS – low intensities facilitate neural activity and behavior whereas high intensities induce suppression. The key feature of the model is that these ranges are shifted by changes in neural excitability: consequently, a TMS intensity, which normally induces suppression, can have a facilitatory effect if the stimulated neurons are being inhibited by ongoing task-related processes or preconditioning. For example, adaptation reduces excitability of adapted neurons; the outcome is that TMS intensities which inhibit non-adapted neurons induce a facilitation on adapted neural representations, leading to reversal of adaptation effects. In conventional “virtual lesion” paradigms, similar effects occur because neurons not involved in task-related processes are inhibited by the ongoing task. The resulting reduction in excitability can turn high intensity “inhibitory” TMS to low intensity “facilitatory” TMS for these neurons, and as task-related neuronal representations are in the inhibitory range, the outcome is a reduction in signal-to-noise ratio and behavioral impairment.

Local entrainment of oscillatory activity induced by direct brain stimulation in humans

In a quest for direct evidence of oscillation entrainment, we analyzed intracerebral electroencephalographic recordings obtained during intracranial electrical stimulation in a cohort of three medication-resistant epilepsy patients tested pre-surgically. Spectral analyses of non-epileptogenic cerebral sites stimulated directly with high frequency electrical bursts yielded episodic local enhancements of frequency-specific rhythmic activity, phase-locked to each individual pulse. These outcomes reveal an entrainment of physiological oscillatory activity within a frequency band dictated by the rhythm of the stimulation source. Our results support future uses of rhythmic stimulation to elucidate the causal contributions of synchrony to specific aspects of human cognition and to further develop the therapeutic manipulation of dysfunctional rhythmic activity subtending the symptoms of some neuropsychiatric conditions.

Causal evidence for a privileged working memory state in early visual cortex

Emerging evidence suggests that items held in working memory (WM) might not all be in the same representational state. One item might be privileged over others, making it more accessible and thereby recalled with greater precision. Here, using transcranial magnetic stimulation (TMS), we provide causal evidence in human participants that items in WM are differentially susceptible to disruptive TMS, depending on their state, determined either by task relevance or serial position. Across two experiments, we applied TMS to area MT+ during the WM retention of two motion directions. In Experiment 1, we used an "incidental cue" to bring one of the two targets into a privileged state. In Experiment 2, we presented the targets sequentially so that the last item was in a privileged state by virtue of recency. In both experiments, recall precision of motion direction was differentially affected by TMS, depending on the state of the memory target at the time of disruption. Privileged items were recalled with less precision, whereas nonprivileged items were recalled with higher precision. Thus, only the privileged item was susceptible to disruptive TMS over MT+. By contrast, precision of the nonprivileged item improved either directly because of facilitation by TMS or indirectly through reduced interference from the privileged item. Our results provide a unique line of evidence, as revealed by TMS over a posterior sensory brain region, for at least two different states of item representation in WM.

Perturbing the action observation network during perception and categorization of actions' goals and grips: state-dependency and virtual lesion TMS effects

Watching others grasping and using objects activates an action observation network (AON), including inferior frontal (IFC), anterior intraparietal (AIP), and somatosensory cortices (S1). Yet, causal evidence of the differential involvement of such AON sensorimotor nodes in representing high- and low-level action components (i.e., end-goals and grip type) is meager. To address this issue, we used transcranial magnetic stimulation-adaptation (TMS-A) during 2 novel action perception tasks. Participants were shown adapting movies displaying a demonstrator performing goal-directed actions with a tool, using either power or precision grips. They were then asked to match the end-goal (Goal-recognition task) or the grip (Grip-recognition task) of actions shown in test pictures to the adapting movies. TMS was administered over IFC, AIP, or S1 during presentation of test pictures. Virtual lesion-like effects were found in the Grip-recognition task where IFC stimulation induced a general performance decrease, suggesting a critical role of IFC in perceiving grips. In the Goal-recognition task, IFC and S1 stimulation differently affected the processing of "adapted" and "nonadapted" goals. These "state-dependent" effects suggest that the overall goal of seen actions is encoded into functionally distinct and spatially overlapping neural populations in IFC-S1 and such encoding is critical for recognizing and understanding end-goals.

Continuous theta burst transcranial magnetic stimulation reduces resting state connectivity between visual areas

Continuous theta burst stimulation (cTBS) is a technique that allows for altering of brain activity. Research to date has focused on the effect of cTBS on the target area, but less is known about its effects on the resting state functional connectivity between different brain regions. We investigated this issue by applying cTBS to the occipital cortex and probing its influence in retinotopically defined regions in early visual cortex using functional MRI. We found that occipital cTBS reliably decreased the resting state functional connectivity (i.e., the correlation of spontaneous activity) between regions of the early visual cortex. In the context of a perceptual task, such an effect could mean that cTBS affects the strength of the perceptual signal, its variability, or both. We investigated this issue in a second experiment in which subjects performed a perceptual discrimination task and indicated their level of certainty on each trial. The results showed that occipital cTBS decreased both subjects' accuracy and confidence. Signal detection modeling suggested that these impairments resulted primarily from a decreased strength of the perceptual signal, with a nonsignificant trend of a decrease in signal variability. We discuss the implications of these experiments for understanding the mechanisms by which cTBS influences brain activity and perceptual processes.

Enhancement of human cognitive performance using transcranial magnetic stimulation (TMS)

Here we review the usefulness of transcranial magnetic stimulation (TMS) in modulating cortical networks in ways that might produce performance enhancements in healthy human subjects. To date over sixty studies have reported significant improvements in speed and accuracy in a variety of tasks involving perceptual, motor, and executive processing. Two basic categories of enhancement mechanisms are suggested by this literature: direct modulation of a cortical region or network that leads to more efficient processing, and addition-by-subtraction, which is disruption of processing which competes or distracts from task performance. Potential applications of TMS cognitive enhancement, including research into cortical function, rehabilitation therapy in neurological and psychiatric illness, and accelerated skill acquisition in healthy individuals are discussed, as are methods of optimizing the magnitude and duration of TMS-induced performance enhancement, such as improvement of targeting through further integration of brain imaging with TMS. One technique, combining multiple sessions of TMS with concurrent TMS/task performance to induce Hebbian-like learning, appears to be promising for prolonging enhancement effects. While further refinements in the application of TMS to cognitive enhancement can still be made, and questions remain regarding the mechanisms underlying the observed effects, this appears to be a fruitful area of investigation that may shed light on the basic mechanisms of cognitive function and their therapeutic modulation.

Vicarious motor activation during action perception: beyond correlational evidence

Neurophysiological and imaging studies have shown that seeing the actions of other individuals brings about the vicarious activation of motor regions involved in performing the same actions. While this suggests a simulative mechanism mediating the perception of others' actions, one cannot use such evidence to make inferences about the functional significance of vicarious activations. Indeed, a central aim in social neuroscience is to comprehend how vicarious activations allow the understanding of other people's behavior, and this requires to use stimulation or lesion methods to establish causal links from brain activity to cognitive functions. In the present work, we review studies investigating the effects of transient manipulations of brain activity or stable lesions in the motor system on individuals' ability to perceive and understand the actions of others. We conclude there is now compelling evidence that neural activity in the motor system is critical for such cognitive ability. More research using causal methods, however, is needed in order to disclose the limits and the conditions under which vicarious activations are required to perceive and understand actions of others as well as their emotions and somatic feelings.

Transcranial stimulation and cognition

Noninvasive brain stimulation (NIBS) is a unique method for studying cognitive function. For the study of cognition, NIBS has gained popularity as a complementary method to functional neuroimaging. By bypassing the correlative approaches of standard imaging techniques, it is possible to establish a putative relationship between brain cognition. In fact, functional neuroimaging data cannot demonstrate the actual role of a particular cortical activation in a specific function because an activated area may simply be correlated with task performance, rather than being responsible for it. NIBS can induce a temporary modification of performance only if the stimulated area is causally engaged in the task. In analogy with lesion studies, NIBS can provide information about where and when a particular process occurs. Based on this assumption, NIBS has been used in many different cognitive domains. However, one of the most interesting questions in neuroscience may not be where and when, but how cognitive activity occurs. Beyond localization approaches, NIBS can be employed to study brain mechanisms. NIBS techniques have the potential to influence behavior transiently by altering neuronal activity, which may have facilitatory or inhibitory behavioral effects. NIBS techniques include transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES). TMS has been shown transiently to modulate neural excitability in a manner that is dependent mainly on the timing and frequency of stimulation (high versus low). The mechanism underlying tES is a change in neuronal membrane potentials that appears to be dependent mainly on the direction of current flow (anodal versus cathodal). Nevertheless, the final effects induced by TMS or tES depend on many technical parameters used during stimulation, such as the intensity of stimulation, coil orientation, site of the reference electrode, and time of application. Moreover, an important factor is the possible interactions between these factors and the physiological and cognitive state of the subject. To use NIBS in cognition, it is important to understand not only how NIBS functions but also the brain mechanisms being studied and the features of the area of interest. To describe better the advanced knowledge provided by NIBS in cognition, we will treat each NIBS technique separately and underline the related hypotheses beyond applications.

Modeling noninvasive neurostimulation in epilepsy as stochastic interference in brain networks

Noninvasive brain stimulation is one of very few potential therapies for medically refractory epilepsy. However, its efficacy remains suboptimal and its therapeutic value has not been consistently assessed. This is in part due to the nonoptimized spatio-temporal application of stimulation protocols for seizure prevention or arrest, and incomplete knowledge of the neurodynamics of seizure evolution. Through simulations, this study investigated electroencephalography (EEG)-guided, stochastic interference with aberrantly coordinated neuronal networks, to prevent seizure onset or interrupt a propagating partial seizure, and prevent it from spreading to large areas of the brain. Brain stimulation was modeled as additive white or band-limited noise, and simulations using real EEGs and data generated from a network of integrate-and-fire neuronal ensembles were used to quantify spatio-temporal noise effects. It was shown that additive stochastic signals (noise) may destructively interfere with network dynamics and decrease or abolish synchronization associated with progressively coupled networks. Furthermore, stimulation parameters, particularly amplitude and spatio-temporal application, may be optimized based on patient-specific neurodynamics estimated directly from noninvasive EEGs.

Effects of TMS over Premotor and Superior Temporal Cortices on Biological Motion Perception

Using MRI-guided off-line TMS, we targeted two areas implicated in biological motion processing: ventral premotor cortex (PMC) and posterior STS (pSTS), plus a control site (vertex). Participants performed a detection task on noise-masked point-light displays of human animations and scrambled versions of the same stimuli. Perceptual thresholds were determined individually. Performance was measured before and after 20 sec of continuous theta burst stimulation of PMC, pSTS, and control (each tested on different days). A matched nonbiological object motion task (detecting point-light displays of translating polygons) served as a further control. Data were analyzed within the signal detection framework. Sensitivity (d′) significantly decreased after TMS of PMC. There was a marginally significant decline in d′ after TMS of pSTS but not of control site. Criterion (response bias) was also significantly affected by TMS over PMC. Specifically, subjects made significantly more false alarms post-TMS of PMC. These effects were specific to biological motion and not found for the nonbiological control task. To summarize, we report that TMS over PMC reduces sensitivity to biological motion perception. Furthermore, pSTS and PMC may have distinct roles in biological motion processing as behavioral performance differs following TMS in each area. Only TMS over PMC led to a significant increase in false alarms, which was not found for other brain areas or for the control task. TMS of PMC may have interfered with refining judgments about biological motion perception, possibly because access to the perceiver's own motor representations was compromised.

Direct injection of noise to the visual cortex decreases accuracy but increases decision confidence

The relationship between accuracy and confidence in psychophysical tasks traditionally has been assumed to be mainly positive, i.e., the two typically increase or decrease together. However, recent studies have reported examples of exceptions, where confidence and accuracy dissociate from each other. Explanations for such dissociations often involve dual-channel models, in which a cortical channel contributes to both accuracy and confidence, whereas a subcortical channel only contributes to accuracy. Here, we show that a single-channel model derived from signal detection theory (SDT) can also account for such dissociations. We applied transcranial magnetic stimulation (TMS) to the occipital cortex to disrupt the internal representation of a visual stimulus. The results showed that consistent with previous research, occipital TMS decreased accuracy. However, counterintuitively, it also led to an increase in confidence ratings. The data were predicted well by a single-channel SDT model, which posits that occipital TMS increased the variance of the internal stimulus distributions. A formal model comparison analysis that used information theoretic methods confirmed that this model was preferred over single-channel models, in which occipital TMS changed the signal strength or dual-channel models, which assume two different processing routes. Thus our results show that dissociations between accuracy and confidence can, at least in some cases, be accounted for by a single-channel model.

Transcranial magnetic stimulation modulates the brain's intrinsic activity in a frequency-dependent manner

Intrinsic activity in the brain is organized into networks. Although constrained by their anatomical connections, functional correlations between nodes of these networks reorganize dynamically. Dynamic organization implies that couplings between network nodes can be reconfigured to support processing demands. To explore such reconfigurations, we combined repetitive transcranial magnetic stimulation (rTMS) and functional connectivity MRI (fcMRI) to modulate cortical activity in one node of the default network, and assessed the effect of this upon functional correlations throughout the network. Two different frequencies of rTMS to the same default network node (the left posterior inferior parietal lobule, lpIPL) induced two topographically distinct changes in functional connectivity. High-frequency rTMS to lpIPL decreased functional correlations between cortical default network nodes, but not between these nodes and the hippocampal formation. In contrast, low frequency rTMS to lpIPL did not alter connectivity between cortical default network nodes, but increased functional correlations between lpIPL and the hippocampal formation. These results suggest that the default network is composed of (at least) two subsystems. More broadly, the finding that two rTMS stimulation regimens to the same default network node have distinct effects reveals that this node is embedded within a network that possesses multiple, functionally distinct relationships among its distributed partners.

Accurate and rapid estimation of phosphene thresholds (REPT)

To calibrate the intensity of transcranial magnetic stimulation (TMS) at the occipital pole, the phosphene threshold is used as a measure of cortical excitability. The phosphene threshold (PT) refers to the intensity of magnetic stimulation that induces illusory flashes of light (phosphenes) on a proportion of trials. The existing PT estimation procedures lack the accuracy and mathematical rigour of modern threshold estimation methods. We present an improved and automatic procedure for estimating the PT which is based on the well-established Ψ Bayesian adaptive staircase approach. To validate the new procedure, we compared it with another commonly used procedure for estimating the PT. We found that our procedure is more accurate, reliable, and rapid when compared with an existing PT measurement procedure. The new procedure is implemented in Matlab and works automatically with the Magstim Rapid(2) stimulator using a convenient graphical user interface. The Matlab program is freely available for download.